01070098 CHOY OF CUPERTINO
Hau,mNG DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
21831 MC CLELLAN RD WING JIK CHEA 01CC0Pr700SS98
TN'NJME 561 RUTGERS ST 07/23/2001
PHONE- �1I i1�1 (510) 481-3818 SANITARY NO. CONTROL NO.
QO O ARCHITEC iENGINEER: - BUILDING PERMIT INFO
F w- BLDG ELECT PLUMB MECH
u LJ LJ IJ I I
LICENSED CONTRACT'OR'S DECLARATION
2 z.i I hereby affirm that l am licensed under provisions of Chapter (commencing REROOF. lob Description
�_FE with Section Divisimt 3ot the Business and Prafessions Cade,and my licensx
<x inut once deme<t. 6 ��� k T/O EXISTING WOODSHAKE &
e m License CI s Lic.a
ad d Data y — eamraetar 1 INSTALL PLYOOD & ASPHALT SHINGLE.
F ARCHITECT ll hie u e DECLARATIO
g 1 undecuand my plans shall od used as public records
to i p C Licensed Professi...I
OWNER-BUILDER DECLARATION
to
=n 1 hereby affirm that I am exempt from the Contrxtor't License Law for the
c•a a following mason.(Section 7031.5,Business and Professions Codc:Any city normally-
which
rcounty-
which requires a permit to construct,aper,improve,demolish,or repair any structure
u,3'b -prise . t mce,alsoq th .pplicamI ...ah permit m tate
fleasgncd sment. .._-. -._
a. math,is licialledwRbatmtMp -'uanaormecarat License La.(Chapmr9 , 5 FLFloor•Area„ section
(comm og th Sect 700 pf D'visiun 3 of the Business and Professions Code) ♦"+-'' '
or that he ii exempt thaeBom and the basis for the alleg6l el:fmption.Any violation t
of Section 4031.5 by any applicam for a permit subjects the applicant to a civil pewhy
Iof not mum than five hundred dollars 550()). 357A❑A4i 8 V
0 '<,.a,... ..;., Occupancy Type
❑1,as owner of the propcny,or my employees with wages m their sale compensation,
-will do the,wark,'und the aru<tare'ti not immEdcd or offeredforsale(See.704,1.- 305 - FRAME Required Inspections,"'
Business and Professions Code:The Cmmar 'x License Law rose,not apply m an q '
owner of progeny Who builds or improves In,..and who does such worx himself 307 - INSULATION '
or th ou h his n erupt Y<e. provided th t.such imp met t tended or s
g _
offeredf -r Ir n it to buddi
have
Pra t Id phi Y mild 607 = ROOF-TEAR 'OFF "`completion,th h'e. Illi m burden rpMilitia,h did tb Id or I '
p forwmox r Side.). 602 - ROOF PLYWOOD NAIL
[7'i - nn p pony exclusivelycontracting withl dr tract-too -'- - 603 -'ROOF—BATTENS--- -
construct thproject(S70,14Business andProfessions c,aaTn Contractor xj
604 - ROOF IN-PROGRESS
St'
License Low does no,ii,plym an owne,of property who Wild, improves mere°°.
.and who.contracts for such groped with a cumdUCIM)hemssed pursaam to the.
Contractors License Law. /
❑I am exempt under Sec. ,B&Pcfnr this reason
ovine •• Data - • .
"W ORKEKS COMPENSATION DECLARATION
1 hereby Effort under P rutty of perjury sine of the bDllowing declamtic m:
❑ 1 have and will mairamn'aCcnifcade of Consent to self-insure,for Worker's
Compenamian, as;provided Ba by Station 3700 of the labor Code, for the
s.
perfmmence of the work fur which this pe!? iu is issued
❑1 Im and'SSM maintain Woiter'.i Compenmtion Initim ce,as required by Section
37W of lh Leri'C61e f thefa torn f the erk f which thispeon t-s
issue d MY Wo k r.C mpe(n�sanon 1 mote carrier d Policy number aR m ` •,
C' EVrl<YN°. Dtr, f) _.-. 1=� ss 1f V. ^ ." ' at - .. -•.__ _�T_.J. -_- _- -
LtnFICA116NO KEMITION R M.WORKEf✓IS v 1 I S E l.I•'- +s
r ._ COMPENSATION INSURANCEh
1' t (TK secuonneed not becomplcted if the permit ix for one hundred dollars
151001 nr lass.) t. - •, , ,
1'e n(y mai tri the pe a an, ra an' work for mine Ms pmol r
'shall not employ anY.Peleon m,any manner s°us m 6lcome sublect at me Workers
Cnlnpenaltinn Luwx of Cnl'domia.Date,
. 'Applicant -. . . .. .. . .. s :. .. .. .. _.. - - _._ .... _.... _..... _ . . .. ..-....._
NOTICE TO APPLICANT IL after making his Ccmfcac ofEemption.you should '•s•' ' r
liccanoi subject 4s the Weiker's Compensation pmJisions of the Labor Code.Yoo must
O
forthwith cnmP1Y w.�CONSTRUCTCOn LENDING
.. .cd. ......_ ...... .. .. ..... _ .. ..
m M1 provisions or t hall had d k
AGCNCY'
1h by 0 d gagencyf theperfmonnce '
of th k f r wb¢h to pc t :iucJ IS 1(19] Civ,C 1
Lender's Nans" u...__...___ _.. ._. . _. ...- . I
y-C Lemler'iAdunit,
V'Q I ec,it,that 1 have read this Ep,lsration and scam that the ahme infonnati°n is
• Ba"ra
correct:I agree to comply with all city and county ordinances and state laws relating
- C-U to building construction.and hereby aumod4c representatives of this city to cmcr upon
' �.'.Wthe abtwe-mentioned property forLinspection purposes.
F•t'd IWej ugrce m slue,indemnify send keep M1aemleus the Clry of al gainst
-W liabilities,judgment,costs and expenses which may in any way warm,against,said
C.1 z City mnseq encc of thegranting f tb pc t is
APPIICAN'T tINDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURC R U Issued by: Date
:. t ApP o ... s Data 1 Re-roofs
Code. A RDOUS MATERIALS DISCLOSURE
:. 7 .�, Wdlfle hpplicantm,fua.bodding occupant store oT handle haEardous mmenal ,Typeof.Roof..,. ._. .. .. _..... ...._ ... . .,. .. ._.. ..
',fined by the Cupertino M a Al Code.Chapter 9.12,and the Health and Safety' , •. •.-„ �.. - �,,:,a"•,
e.Section2553,,,,?, ...... ..
_ cT ., a�l tris•.+ i '..
El ,' :1 fir" :• All.roofs shall be-inspected prior to_any_roofing material being installed.. . . .. .
vru.tn �pr<nw i t n i�ding <aaPant sae eq 'p t d wn�<n' If a roof is installed without first obtaining an'inspection,'I'agree'to remove
eruct hmardous air com ,nt. J fined by the Bay Area A Q I ty M.Mag mem,
Dikirit,0 all new materials for,inspection. Applicant understands and.will,coinply with
„T ❑Y.-. 'cl - all non-point source regulations
1 jitoulbh - d theh boddo mater I req t u d Ch fo 695 of me f� ///1 •^^���
Cat( in Rh&5ade,fly Cod Sections255.15 5 and 25534.I understand.rand mat six,
if p Id gdrc& tenant..- thtit is
yr C hl tydY the
o a pant omems h c� h 'sent Ie met P to isi nee°f a Cen t cmc of _ ..
°"apo y Z ) Signature of Appli an[ Date
Dal/ All roof coverings to be Class "B"or better
- - - " OFFICE- _ -